Scalenes pain & trigger points

Troubling scalenes can give you pain in a lot of body regions – from the front and back of your arms, over to your chest to your upper back –.

Treatment of this muscle group can be demanding because they are pretty difficult to feel and massage.

1. Pain patterns and symptoms

If these muscles contain trigger points, they can give you pain in the most versatile regions at the front of your body.

The deeper the red in the pictures below, the more common it is to experience pain in those areas, when trigger points are troubling these neck muscles.

It contributes to…

Visualization of the pain patterns

1
2
3

1.2 Symptoms & complaints

Compared to the diversity of pain patterns these muscles can create, there are not too many movements that may be impaired or painful when they are too tight or contain tender or trigger points.

The only ones I read about were a minimal limitation of neck rotation and some stiffness of your fingers on the same side.

  • The scalene muscle consist of three parts.
  • An anterior/front, medial/mid and posterior/back part.
  • All three parts originate at the side of your neck vertebras and run to the first or second rib.

3. Scalenes function

When both sides of these muscles contract, they flex the neck. Contraction of just one side leads to a flexion of the neck to the same side.

Furthermore they help to lift the ribcage and work together with the diaphragm in quiet breathing. This means they are assistant breathing muscles.

1

Flexion at the neck

2

Lateral flexion at the neck

4. Trigger point activation in the scalenes

Although these muscles work during quiet breathing, they can get overworked during paradox breathing – breathing mainly with your chest –.

During paradox breathing your diaphragm is “not working properly”.

Among others, your scalenes will compensate for that, but as they are not meant to be the main workhorses for breathing they get overworked pretty quickly.

Furthermore these muscles can be affected by any gait pattern that deviates from the norm.

This means limping, having a “shorter” leg or something similar can be the decisive reason why those muscles tighten up or develop trigger points.

5. Palpation of the scalenes

These muscles are partly hidden by your sternocleidomastoideus.

This will make it a little challenge for you to feel them. Just take your time. You most certainly do not have to able to do it straight away.

5.1 Palpation of the scalenus anterior and medialis

To get onto the s. anterior – the one that sits in the very front – you have to move your sternocleidomastoideus to the side.

To do so, pinch it with your fingers and then pull it a little forward into the direction of your voice box/larynx.

Now you have access to the front division of the muscle. But here, get your fingers in front of your neck to feel the muscle. You have to access it from the very front.

You are literally pressing the muscle against the neck vertebras.

Use the same technique to feel the middle part. Just feel at the side of your neck instead of the front.

1

Pulling the sternocleidomastoideus away

2

Pushing against the scalenes

5.2 Palpation of the scalenus posterior

To palpate the posterior/back part of your scalenes, push with your fingers into the spot where your collarbone meets your trapezius.

6. Scalenes self-massage

Trigger and tender points can be found all over these three muscles.

To massage them,  I recommend using your fingertips.

  • Press on the muscle part in question and pull skin over the muscle.
  • This way execute a couple of short massage strokes.

Be aware that between the front and middle part there is a nerve running. Try not to get onto this nerve.

When you have difficulties massaging these muscles I recommend to see a professional and ask for some help. This one is really not that easy.

Still, if you find tender spots or trigger points, work them with slow and precise strokes.

Also be aware that you are applying massage at your neck, which is a very sensitive part of your body.

So I recommend being gentle and going slow.

References

  • Calais-German, Blandine. Anatomy of Movement. Seattle: Eastland Press, 1993. Print
  • Davies, Clair, and Davies, Amber. The Trigger Point Workbook: Your Self-Treatment Guide For Pain Relief. Oakland: New Harbinger Publications, Inc., Print
  • Simons, David G., Lois S. Simons, and Janet G. Travell. Travell & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore, MD: Williams & Wilkins, 1999. Print.
  • Schünke, Michael., Schulte, Erik, and Schumacher, Udo. Prometheus: Lernatlas der Anatomie. Stuttgart/New York: Georg Thieme Verlag, 2007. Print
  • Nix, Wilfred A. Muscles, Nerves And Pain. Berlin Heidelberg: Springer Verlag, 2012. Print